Course of activities of daily living in nursing home residents with dementia from admission to 36-month follow-up

Abstract Background Dementia is affecting both the person with the disease and the family members. It is associated with nursing home admission, and a reduced ability to perform personal activities of daily living (P-ADL). The aim of this study was to examine the association between the severity of dementia and P-ADL function, and to study if additional factors such as neuropsychiatric symptoms, type of nursing home unit, and use of medication were associated with P-ADL function. Methods A total of 582 nursing home residents with dementia, included at admission to the nursing home, were followed with biannual assessments for 36 months. P-ADL was assessed using the Physical Self-Maintenance scale, and severity of dementia was measured with the Clinical Dementia Rating scale. In addition, neuropsychiatric symptoms, general physical health, and use of medications were assessed at the same time points. Demographic information was collected at baseline. Linear mixed models were estimated. Results There was a significant (p < 0.05) non-linear decline in P-ADL function over time in analysis not adjusting for any characteristics. More severe dementia at baseline and at the follow-up assessments was associated with lower P-ADL function (p < 0.001), with the association being stable over time. A higher level of neuropsychiatric symptoms, not using anti-dementia medication, being in a regular care unit as compared to a special care unit and having poor/fair general physical health as compared to good/excellent, were associated with a lower P-ADL function. Conclusion The association between more severe dementia and lower P-ADL function was stable over a 36-month follow-up period of nursing home residents with dementia. Health care planners and clinicians should be aware of this when planning for and treating nursing home residents.

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Associations between Pain and Quality of Life in Severe Dementia: A Norwegian Cross-Sectional Study

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000468923 ◽

2017 ◽

Vol 7 (1) ◽

pp. 109-121 ◽

Cited By ~ 8

Author(s):

Hanne Marie Rostad ◽

Martine T.E. Puts ◽

Milada Cvancarova Småstuen ◽

Ellen Karine Grov ◽

Inger Utne ◽

...

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Depressive Symptoms ◽

Daily Living ◽

Neuropsychiatric Symptoms ◽

Nursing Home Residents ◽

Severe Dementia ◽

Cross Sectional ◽

The Relationship

Background/Aims: Many variables influence the quality of life in older adults with dementia. We aim to quantify how the relationship between pain and quality of life in nursing home residents with severe dementia can be explained by neuropsychiatric symptoms, depressive symptoms, and activities of daily living. Methods: This article presents cross-sectional baseline data from a cluster randomised controlled trial. Results: The total and direct effects of pain on quality of life were statistically significant. Both neuropsychiatric and depressive symptoms partially mediated the relationship between pain and quality of life. Activities of daily living acted as a mediator only when modelled together with depressive symptoms. Conclusion: Pain, neuropsychiatric symptoms, and depressive symptoms appear to be important factors that influence the quality of life for nursing home residents with severe dementia. Therefore, multidimensional interventions may be beneficial for maintaining or improving quality of life in this population.

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The course of neuropsychiatric symptoms in nursing-home patients with dementia over a 53-month follow-up period

International Psychogeriatrics ◽

10.1017/s1041610213001609 ◽

2013 ◽

Vol 26 (1) ◽

pp. 81-91 ◽

Cited By ~ 76

Author(s):

Geir Selbæk ◽

Knut Engedal ◽

Jūratė Šaltytė Benth ◽

Sverre Bergh

Keyword(s):

Nursing Home ◽

Rating Scale ◽

Neuropsychiatric Symptoms ◽

Clinical Dementia Rating ◽

Severe Dementia ◽

Persistent Symptoms ◽

Nursing Home Patients ◽

Affective Symptoms ◽

Clinically Significant

ABSTRACTBackground:Neuropsychiatric symptoms (NPS) are prevalent in nursing-home (NH) patients with dementia, but little is known about the long-term course of these symptoms.Methods:In this study, 931 NH patients with dementia took part in a prospective cohort study with four assessments over a 53-month follow-up period. NPS and level of dementia were assessed with the Neuropsychiatric Inventory scale and the Clinical Dementia Rating scale, respectively.Results:Mild, moderate, and severe dementia was present in 25%, 33%, and 42%, respectively. There was an increase in the severity of the dementia from the first to the fourth assessment. Agitation, irritability, disinhibition, and apathy were the most prevalent and persistent symptoms during the study period. The affective subsyndrome (depression and anxiety) became less severe, whereas the agitation subsyndrome (agitation/aggression, disinhibition, and irritability) and apathy increased in severity during the follow-up period. More severe dementia was associated with more severe agitation, psychosis, and apathy, but not more severe affective symptoms. Mild dementia was associated with an increase in the severity of psychosis, whereas moderate or severe dementia was associated with decreasing severity of psychosis over the follow-up period.Conclusion:Nearly all the patients experienced clinically significant NPS, but individual symptoms fluctuated. Affective symptoms became less severe, while agitation and apathy increased in severity. An increase in dementia severity was associated with an increase in the severity of agitation, psychosis, and apathy, but not affective symptoms. The results may have implications when planning evaluation, treatment, and the prevention of NPS in NH patients.

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Prescribing pattern of psychotropic drugs in nursing home residents with dementia

International Psychogeriatrics ◽

10.1017/s1041610211000755 ◽

2011 ◽

Vol 23 (8) ◽

pp. 1249-1259 ◽

Cited By ~ 57

Author(s):

R. B. Wetzels ◽

S. U. Zuidema ◽

J. F. M. de Jonghe ◽

F. R. J. Verhey ◽

R. T. C. M. Koopmans

Keyword(s):

Nursing Home ◽

Psychotropic Drug ◽

Anatomical Therapeutic Chemical ◽

Neuropsychiatric Symptoms ◽

Nursing Home Residents ◽

Severe Dementia ◽

Prescribing Pattern ◽

Antidementia Drugs ◽

Utilization Patterns ◽

To Receive

ABSTRACTBackground: The goal of this study is to determine patterns of psychotropic drug use (PDU), the association with neuropsychiatric symptoms (NPS), and the variability across dementia types in nursing home residents with dementia. In addition, PDU was analyzed across multiple indications.Methods: This was a prospective cohort study over a two-year period from 2006 to 2008, which involved 14 dementia special care units in nine nursing homes. A total of 117 residents with dementia participated in the study, of whom 35% had Alzheimer's dementia (AD) and 11% vascular dementia (VaD). PDU was classified according to anatomical therapeutic chemical-classification as either “present” or “absent”.Results: The majority of residents had moderately severe to severe dementia. At all successive assessments, almost two-thirds of residents received any psychotropic drug (PD) and almost one-third continued to receive any PD. Of all PDs, antipsychotics (APs) were prescribed most frequently. Fewer residents started with antidepressants, but continued to receive antidepressants at higher percentages. Anxiolytics showed an intermittent course, but a subgroup of 9% showed two-year continuation. Once started on PDs at baseline, residents continued to use PDs at high percentages: three-quarters continued to receive APs for at least six months. Half of residents received at least one PD; one-fifth received at least two PDs simultaneously. Residents with AD received more hypnotics and antidementia drugs; residents with VaD received more antipsychotics, antidepressants, anxiolytics and anticonvulsants.Conclusions: PDs have different utilization patterns, but overall, consistently high continuation rates were found. These results warrant scrutiny of continuous PDU.

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Correction: The course of neuropsychiatric symptoms in nursing home residents from admission to 30-month follow-up

PLoS ONE ◽

10.1371/journal.pone.0209875 ◽

2018 ◽

Vol 13 (12) ◽

pp. e0209875

Author(s):

Anne-Sofie Helvik ◽

Geir Selbæk ◽

Jūratė Šaltytė Benth ◽

Irene Røen ◽

Sverre Bergh

Keyword(s):

Nursing Home ◽

Neuropsychiatric Symptoms ◽

Nursing Home Residents

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Is the Tinetti Performance Oriented Mobility Assessment (POMA) a feasible and valid predictor of short-term fall risk in nursing home residents with dementia?

International Psychogeriatrics ◽

10.1017/s1041610209991347 ◽

2009 ◽

Vol 22 (2) ◽

pp. 254-263 ◽

Cited By ~ 41

Author(s):

Carolyn S. Sterke ◽

Sawadi L. Huisman ◽

Ed F. van Beeck ◽

Caspar W. N. Looman ◽

Tischa J. M. van der Cammen

Keyword(s):

Regression Analysis ◽

Nursing Home ◽

Predictive Validity ◽

Nursing Home Residents ◽

Area Under The Curve ◽

Short Term ◽

Severe Dementia ◽

Mobility Assessment ◽

Specific Objective

ABSTRACTBackground:The feasibility and predictive validity of balance and gait measures in more severe stages of dementia have been understudied. We evaluated the clinimetric properties of the Tinetti Performance Oriented Mobility Assessment (POMA) in nursing home residents with dementia with a specific objective of predicting falls in the short term.Methods:Seventy-five ambulatory nursing home residents with dementia, mean age 81 ± 8 years, participated in a prospective cohort study. All participants underwent the full POMA-test. Fall statistics were retrieved from incident reports during a three-months follow-up period. The predictive validity was expressed in terms of sensitivity and specificity. Loglinear regression analysis was used to examine the relationship between POMA scores and the occurrence of a fall.Results:The POMA showed several feasibility problems, with 41% of patients having problems in understanding one or more instructions. The inter-rater reliability of the instrument was good. The predictive validity was acceptable, with a sensitivity of 70–85% and a specificity of 51–61% for the POMA and its subtests, and an area under the curve (AUC) of 0.70 for POMA-Total (95% CI: 0.53–0.81), 0.67 for POMA-Balance (95% CI: 0.52–0.81), and 0.67 for POMA-Gait (95% CI: 0.53–0.81). After loglinear regression analysis, only POMA-T was significant in predicting a fall (adjusted HR = 1.08 per point lower; 95% CI 1.00–1.17).Conclusions:Application of the POMA in populations with moderate to severe dementia is hampered by feasibility problems. Its implementation in clinical practice cannot therefore be recommended, despite an acceptable predictive validity. To refine our findings, large prospective studies on the predictive validity of the POMA in populations with mild, moderate and severe dementia are needed. In addition, the performance of mobility assessment methods that are less dependent on cognition should be evaluated.

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Stability of the factor structure of the Neuropsychiatric Inventory in a 31-month follow-up study of a large sample of nursing-home patients with dementia

International Psychogeriatrics ◽

10.1017/s104161021100086x ◽

2011 ◽

Vol 24 (1) ◽

pp. 62-73 ◽

Cited By ~ 53

Author(s):

Geir Selbæk ◽

Knut Engedal

Keyword(s):

Nursing Home ◽

Factor Structure ◽

Neuropsychiatric Symptoms ◽

Neuropsychiatric Inventory ◽

Large Sample ◽

Nursing Home Patients ◽

Affective Symptoms ◽

The Stability ◽

Over Time

ABSTRACTBackground: Neuropsychiatric symptoms (NPS) are highly prevalent among nursing home patients with dementia. Several studies have investigated subsyndromes of NPS but the stability of these subsyndromes over time has rarely been examined. We have examined the stability over time of the factor structure of the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) in a large sample of nursing-home patients with dementia.Methods: Nursing-home patients with dementia were assessed with the NPI-NH at baseline (n = 895), and at 12-month (n = 592) and 31-month (n = 278) follow-up assessments, giving three partly overlapping samples. Exploratory factor analysis was done to investigate neuropsychiatric subsyndromes of the NPI-NH at each assessment in these samples.Results: Three- or four-factor solutions were found, termed agitation, psychosis, apathy, and affective symptoms. Depression and anxiety (affective), delusion and hallucination (psychosis), and agitation and irritability (agitation) were the symptoms that most often co-occurred in the same factor. Apathy did not load together with affective symptoms at any of the assessments.Conclusions: Subsyndromes of the NPI-NH are relatively stable over 31-month follow-up assessments in nursing-home patients with dementia, indicating that these subsyndromes may be useful for following the natural course of symptoms as well as observing the effect of interventions. Our findings lend support to the distinction between apathy and affective symptoms, which may have important clinical implications.

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Predictors of Functional Decline in Nursing Home Residents: The Shelter Project

The Journals of Gerontology Series A ◽

10.1093/gerona/glz296 ◽

2019 ◽

Vol 75 (8) ◽

pp. 1600-1605 ◽

Cited By ~ 1

Author(s):

Massimiliano Fedecostante ◽

Graziano Onder ◽

Paolo Eusebi ◽

Giuseppina Dell’Aquila ◽

Elisa Zengarini ◽

...

Keyword(s):

Urinary Incontinence ◽

Nursing Home ◽

Protective Factor ◽

Functional Decline ◽

Nursing Home Residents ◽

Quality Of Healthcare ◽

Severe Dementia ◽

Mixed Effect

Abstract Background The aim of our study was to identify independent predictors of functional decline in older nursing home (NH) residents, taking into account both resident and facility characteristics. Methods Longitudinal observational study involving 1,760 older (≥65 y) residents of NH participating in the SHELTER* study (57 NH in eight countries). All residents underwent a comprehensive geriatric assessment using the interRAI LTCF. Functional decline was defined as an increase of at least one point in the MDS Long Form ADL scale during a 1 year follow-up. Facility and country effects were taken into account. Results During the study period 891 (50.6%), NH residents experienced ADL decline. Residents experiencing ADL decline were older, had lower disability at baseline, were more frequently affected by severe dementia and by urinary incontinence, and used more antipsychotics. In the mixed-effect logistic regression model, factors independently associated with a higher risk of functional decline were dementia and urinary incontinence, whereas the presence of a geriatrician was a protective factor. Conclusions Both resident and facility characteristics are associated with the risk of functional decline in NH residents. Increasing the quality of healthcare by involving a geriatrician in residents’ care might be an important strategy to improve the outcome of this vulnerable population.

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Prevalence and Severity of Dementia in Nursing Home Residents

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000433525 ◽

2015 ◽

Vol 40 (3-4) ◽

pp. 166-177 ◽

Cited By ~ 43

Author(s):

Anne-Sofie Helvik ◽

Knut Engedal ◽

Jūratė Šaltytė Benth ◽

Geir Selbæk

Keyword(s):

Nursing Home ◽

Rating Scale ◽

Unit Length ◽

Nursing Home Residents ◽

Linear Regression Models ◽

Clinical Dementia Rating ◽

Severe Dementia ◽

People With Dementia ◽

Severity Of Dementia ◽

Single Men

Background/Aims: The aim of this study was to compare the presence and severity of dementia in two large cross-sectional samples of nursing home residents from 2004/2005 and 2010/2011. Methods: Demographic information as well as data on the type of nursing home unit, length of stay before assessment, physical health, regularly used prescribed drugs and Clinical Dementia Rating scale scores were used in the analyses. Logistic and linear regression models for hierarchical data were estimated. Results: The odds of the occurrence and of a greater severity of dementia were higher in 2010/2011 than in 2004/2005. Independent of the time of study, married men had more severe dementia than single men, and single women had more severe dementia than single men. Conclusion: The findings may reflect the increase in the need for more nursing home beds designed for people with dementia between 2004/2005 and 2010/2011.

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Impact of the Sonas Programme on Communication over a Period of 24 Weeks in People with Moderate-to-Severe Dementia

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000489041 ◽

2018 ◽

Vol 8 (2) ◽

pp. 238-247

Author(s):

Benedicte Sørensen Strøm ◽

Jūratė Šaltytė Benth ◽

Knut Engedal

Keyword(s):

Nursing Home ◽

Cognitive Abilities ◽

Linear Trend ◽

Nursing Home Residents ◽

Descriptive Study ◽

Verbal Communication ◽

Communication Tool ◽

Severe Dementia ◽

The Impact ◽

Over Time

Objectives: The primary aim was to examine how communication abilities changed over time among nursing home residents with moderate-to-severe dementia who were attending the Sonas programme and to explore whether changes in communication abilities were related to cognitive ability. Method: A longitudinal secondary descriptive study method was employed, where 56 people with moderate-to-severe dementia attended a 45-min Sonas group session twice a week for 24 weeks. The Threadgold Communication Tool (TCT) was completed every 4 weeks. Results: The impact of the Sonas programme on communication showed a significant non-linear trend in the TCT, with an increase in communication abilities during the first 16 weeks, regardless of the level of the residents’ cognitive abilities. Thereafter it levelled out. No interaction was found between time and the frequency of attendances at Sonas sessions. Both verbal and non-verbal communication increased from the baseline, with non-verbal communication increasing quickly and verbal communication increasing marginally. Conclusion: Communication abilities increased with the time of the intervention, but the peak was achieved after 16 weeks, after which the effect levelled out. This suggest that the Sonas programme should be used for a period of at least 16 weeks before evaluating its effect.

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